Female Androgenetic Alopecia: An Update on Diagnosis and Management

  • Michela Starace
  • Gloria Orlando
  • Aurora Alessandrini
  • Bianca Maria PiracciniEmail author
Review Article


Female androgenetic alopecia (FAGA) is a common cause of non-scarring alopecia in women. The onset may be at any age following puberty and the frequency increases with age. Clinically, it shows a diffuse hair thinning over the central scalp, while the frontal hairline is usually retained. FAGA can have a significant psychological impact, leading to anxiety and depression. For this reason, early diagnosis is very important to stop the progression of the disease. The sex hormonal milieu is the main pathogenetic mechanism studied in FAGA. The role of androgens is not clearly defined and only one-third of women with FAGA show abnormal androgen levels. Endocrinological diseases with hyperandrogenism associated with FAGA comprise polycystic ovarian syndrome (PCOS), hyperprolactinemia, adrenal hyperplasia and, rarely, ovarian and adrenal tumours. Usually the diagnosis of FAGA is made clinically. A complete clinical examination and a blood examination can reveal other signs of hyperandrogenism. Trichoscopy shows the typical hair miniaturization. A scalp biopsy can be useful when the clinical evaluation does not provide a definitive diagnosis or when cicatricial alopecias with hair loss in the distribution of FAGA or alopecia areata are suspected. FAGA is a slowly progressive disease. The goal of therapy is to stop the progression and to induce a cosmetically acceptable hair regrowth. The most important drugs are topical minoxidil and oral anti-androgens. The purpose of this review is to provide an update on FAGA and to create a guideline on diagnosis and management of this frequent hair disease, not always easily recognizable from cicatricial alopecias with a similar distribution.


Author contributions

All authors contributed to the design, data acquirement, writing and editing.

Compliance with Ethical Standards


This article has no funding source.

Conflict of interest

Michela Starace, Gloria Orlando, Aurora Alessandrini, and Bianca Maria Piraccini have no conflicts of interest to declare.


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Michela Starace
    • 1
  • Gloria Orlando
    • 2
  • Aurora Alessandrini
    • 1
  • Bianca Maria Piraccini
    • 1
    Email author
  1. 1.Division of Dermatology, Department of Experimental, Diagnostic and Specialty MedicineUniversity of BolognaBolognaItaly
  2. 2.Unit of Dermatology, Department of Medicine-DIMEDUniversity of PadovaPaduaItaly

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